A series of projects under the Skills for Health banner is developing new roles to support the ever-changing health service

Much of the work of Skills for Health supports healthcare employers and strategic organisations in meeting rapidly changing demands in service provision and balance. This is being achieved by a competence-based approach to developing skills in new and extended roles, while introducing flexible working and new career pathways at all levels of the workforce.

It entails a mix of project streams, dedicated teams and competence frameworks and application tools. Some specific projects have already enhanced roles, responded to changes in models of care or met gaps in service provision.

Exemplar projects

In the West Midlands, Skills for Health has been supporting the strategic health authority in developing a competence-based workforce. Four exemplar projects are under way, reporting on their first phase by the spring of 2009.

One project is developing a career framework for the theatre workforce, from porter and operating department assistant to theatre manager. The SHA is examining the environmental features of theatres across the region to understand how departments work, issues of quality and practice and competences needed to optimise productivity.

Another is based on work started at Worcestershire Acute Hospitals trust, extending the healthcare assistant role to allow them to act as scrub assistants during caesarean sections. This freed up 75 hours of midwifery time each week, which was put back into improving continuity of care.

Support for workers making the transition from secondary to primary care is being designed in the shape of a career framework for long-term conditions. Competence-based education and training will be developed to support the framework being trialled across two trusts - one rural, one urban - once the skills gaps have been identified.

The fourth exemplar project in the West Midlands will bring together a skills-based career framework for non-medical clinical staff in emergency and unscheduled care. The early stages are examining the competences required to develop transferable roles that enable emergency care professionals to move across different care environments - walk-in centres, ambulance and paramedical, accident and emergency units.

Nationwide solutions

Skills for Health has now formed a workforce solutions team to work on similar projects and is keen to explore how it can provide services to organisations in all areas of health - primary care, acute and foundation trusts and the independent sector. Using Skills for Health competences and other products such as career frameworks, application tools and processes, workforce solutions will assist these employers on service redesign and development challenges.

In addition, the new ways of working team examines opportunities for workforce innovation. This can be both the creation of new roles and the evolution of existing roles, through additional competence-based training.

"At the moment we have strong links with the 18 weeks programme," says new ways of working divisional manager Kathryn Halford. "Alongside the Department of Health we are looking at pathways where changes to traditional role boundaries might facilitate the ease of movement of patients through the service. This is not just about clinical staff and acute care. It covers a wide spectrum that encompasses people working in every kind of post across the whole of health."

The new ways of working team is also keen to learn from the voluntary and independent sectors. Developments in support for surgeons in the private sector may offer some interesting solutions. Ms Halford says: "Nursing roles for example, where the practitioner has skills in psychologically preparing patients for reconstructive surgery, are proving very effective and could transfer well to the public sector."

The National Workforce Project was established in 2006 and principally assists NHS organisations in England to develop techniques, tools and resources to build capability and capacity through improved workforce planning.

"Maternity Matters and 18 weeks have been among our priorities this year," says national project associate director Sue Dean, "but where we have perhaps done most of our work on flexible working and where trusts have been made to think more creatively is with the European working time directive, for which we are the NHS lead organisation."

Projects across organisational and wider health economies have ranged from handover and team working to feasibility studies of diagnostic services.

"We have about 20 pilot sites, some with the royal colleges and senior clinicians, dedicated to separate work strands," says Ms Dean. "These are all described on our website. We also run a range of conferences, workshops and exhibitions to showcase what's happening - such as the work in Scarborough where, in order to help meet the directive, local GPs have been working alongside A&E consultants and junior doctors."

Thames Valley University also runs a workforce planning certificate programme under the national project, underpinned by Skills for Health competences.

New ways of working

Data from a soon-to-be-completed large-scale evaluation by the new ways of working team could help see the physician assistant role becoming more widespread in primary and secondary care.

The new role - a healthcare professional delivering care and treatment under supervision within the medical team model - was first introduced in the UK in 2002 when three physician assistants were recruited from the US to support a group of GPs in the West Midlands. Adapted and successfully piloted within hospital and primary care teams - the first UK-trained physician assistants completed their training in 2007 - a two-year post-graduate diploma will now be offered at two centres.

"We took on one of the first 'home-grown' PAs at our practice in South London after she did some placement work with us," says Nav Chana, who in his senior lecturer post is helping to develop the new diploma programme at St George's Hospital medical school in London.

"The PA sees patients who turn up without appointments wanting to be seen for headaches, back pain, chest infections etc and, within their scope of competence, deal with whatever they can," Dr Chana continues. "This helps greatly with access and on-the-day demand."

He adds: "I think the role has great potential for supporting healthcare reform, particularly in pressure points such as emergency and acute primary care settings."

Case studies

Two projects provide interesting case studies. One, jointly funded by Skills for Health and NHS Education for Scotland, combined data methodology and Skills for Health assessment tools to produce a detailed picture of service provision for older people in the Highlands region.

Feedback on care being delivered in remote and rural areas highlighted the importance of interpersonal skills, autonomy and prioritisation. Using Skills for Health competences to meet identified service gaps, the new role of rural support worker was created, combining a range of health, home and support care.

This model of more accessible provision means older people are more likely to continue being cared for at home.

In a second project, managers at the Nuffield Hospital Guildford first used competences to develop an effective and error-reducing training package for setting up, monitoring and dismantling syringe pumps.

A similarly successful approach to training for specimen labelling prompted managers to look at how competences could be used to support role development and improve service delivery.

Competences related to monitoring and maintaining people from theatre to ward were used to devise a training package that has helped a Level 3 NVQ healthcare assistant upskill and extend her role, support the recovery team and free up other members of the nursing team.

"We like the Skills for Health competences because they are evidence based, relevant and ready to put in to practice," says Nuffield Hospitals clinical effectiveness nurse Carol Ingleby.

Competence application tools

There are now around 2,500 competences on the national database and it is important Skills for Health's partners understand the variety of ways they can be used, which is where the competence application tools come to the fore.

Project manager Nathan Laxton explains the tools are grouped into three main areas: finding, storing and assessing competences, and there are three tools for finding the competences people might need - a search engine, the Knowledge and Skills Framework mapping tool and the health functional map, which looks at the sector footprint.

To store competences, you register for free with the site. An individual would need to have a role profile stored to go on to use the self-assessment tool.

The team assessment tool is useful for viewing skill-mixes, succession planning and upskilling. They can be particularly helpful in five main areas: role development and redesign, team and service development, skill-mix and strengths appraisal, personal development and planning.